Aström M, Edhag O, Nyquist O, Vallin H
Cardiac Division, Karolinska Institute, Huddinge Hospital, Sweden.
Eur Heart J. 1990 Jan;11(1):35-42. doi: 10.1093/oxfordjournals.eurheartj.a059589.
Controlled studies of the electrophysiological effects of beta-blockade in acute myocardial infarction have not previously been published. In this controlled, double-blind study 20 patients were randomized to treatment with placebo or sotalol administered as a continuous infusion for 12 h. Programmed electrical stimulation was performed from the right atrium. After 60 min of infusion in the sotalol-treated patients (n = 10) there was a significant prolongation of sinus cycle length (+15%) and sinus node recovery time (+28%). The AV nodal effective refractory period was prolonged by 15% after 45 min of infusion. Variables reflecting myocardial repolarization, atrial effective refractory period and QT interval, were increased by 20% and 10%, respectively. In the placebo group, except at 12 h, there was a general pattern of slightly diminishing values for all measured variables. The electrophysiological changes in the sotalol-treated group could be explained by the combined Class II and III activities of this drug. The infusion of sotalol was well tolerated, and the anticipated electrophysiological and Class II and III antiarrhythmic effects were observed, despite the acute myocardial infarction.
此前尚未发表过关于β受体阻滞剂在急性心肌梗死中电生理效应的对照研究。在这项对照双盲研究中，20例患者被随机分为两组，分别接受安慰剂或索他洛尔持续静脉输注12小时的治疗。经右心房进行程控电刺激。在接受索他洛尔治疗的患者（n = 10）输注60分钟后，窦性周期长度显著延长（+15%），窦房结恢复时间延长（+28%）。输注45分钟后，房室结有效不应期延长15%。反映心肌复极的指标、心房有效不应期和QT间期分别增加了20%和10%。在安慰剂组中，除12小时外，所有测量变量的值总体呈略有下降的趋势。索他洛尔治疗组的电生理变化可以用该药物兼具的Ⅱ类和Ⅲ类活性来解释。尽管存在急性心肌梗死，但索他洛尔的输注耐受性良好，且观察到了预期的电生理效应以及Ⅱ类和Ⅲ类抗心律失常作用。
